Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T
Background Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro‐Oncology (RANO) takes a minimum of 4 weeks after the end of treatment. Purpose/Hypothesis To investigate whether chemical exchange saturation transfer (CEST) MRI enables...
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| Veröffentlicht in: | Journal of magnetic resonance imaging 2019-10, Vol.50 (4), p.1268-1277 |
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| creator | Meissner, Jan‐Eric Korzowski, Andreas Regnery, Sebastian Goerke, Steffen Breitling, Johannes Floca, Ralf Omar Debus, Jürgen Schlemmer, Heinz‐Peter Ladd, Mark Edward Bachert, Peter Adeberg, Sebastian Paech, Daniel |
| description | Background
Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro‐Oncology (RANO) takes a minimum of 4 weeks after the end of treatment.
Purpose/Hypothesis
To investigate whether chemical exchange saturation transfer (CEST) MRI enables earlier assessment of response to CRT in glioma patients.
Study Type
Longitudinal prospective study.
Population
Twelve brain tumor patients who underwent definitive CRT were included in this study. Three longitudinal CEST MRI measurements were performed for each patient at 7T: first before, second immediately after completion of CRT, and a third measurement as a 6‐week follow‐up.
Field Strength/Sequence
Conventional MRI (contrast‐enhanced, T2w and diffusion‐weighted imaging) at 3T and T2w and CEST MRI at 7T was performed for all patients.
Assessment
The mean relaxation‐compensated relayed nuclear‐Overhauser‐effect CEST signal (rNOE) and the mean downfield‐rNOE‐suppressed amide proton transfer (dns‐APT) CEST signal were investigated. Additionally, choline‐to‐N‐acetyl‐aspartate ratios (Cho/NAA) were evaluated using single‐voxel 1H‐MRS in six of these patients. Performance of obtained contrasts was analyzed in assessing treatment response as classified according to the updated RANO criteria.
Statistical Test
Unpaired Student's t‐test.
Results
The rNOE signal significantly separated stable and progressive disease directly after the end of therapy (post‐treatment normalized to pre‐treatment mean ± SD: rNOEresponder = 1.090 ± 0.110, rNOEnon‐responder = 0.808 ± 0.155, P = 0.015). In contrast, no significant difference was observed between either group when assessing the normalized dns‐APT (dns‐APTresponder = 0.953 ± 0.384, dns‐APTnon‐responder = 0.972 ± 0.477, P = 0.95). In the smaller MRS subcohort, normalized Cho/NAA decreased in therapy responders (Cho/NAAresponder = 0.632 ± 0.007, Cho/NAAnon‐responder = 0.946 ± 0.124, P = 0.070).
Data Conclusion
rNOE mediated CEST imaging at 7T allowed for discrimination of responders and non‐responders immediately after the end of CRT, additionally supported by 1H‐MRS data. This is at least 4 weeks earlier than the standard clinical evaluation according to RANO. Therefore, CEST MRI may enable early response assessment in glioma patients.
Level of Evidence: 1
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019;50:1268–1277. |
| doi_str_mv | 10.1002/jmri.26702 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2291157779</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2291157779</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3572-a46fffb53d7e9b1ceda6799bced0f58371190ba20ed2f15addd7021cb247887f3</originalsourceid><addsrcrecordid>eNp9kMFO3DAQQK0KVCjtpR-ALHGrFLCddRwfK7S0VCAkRM_RJB7vepXEqe0A-wX97XpZ6JGTR6OnN9Yj5Ctn55wxcbEZgjsXlWLiAznmUohCyLo6yDOTZcFrpo7Ipxg3jDGtF_IjOSpZXS24Lo_J3yWEfksDxsmPESnEiDEOOCbqLV31zg9AJ0gubyJNnhq0bnTJPSLt1jj4AMb5tMYA05bO0Y2rl73roKf43K1hXCGNkOaQJX6kKcAYLQbqBljtaEhU0YfP5NBCH_HL63tCfl8tHy5_Fjd3P64vv98UXSmVKGBRWWtbWRqFuuUdGqiU1m0emJV1qTjXrAXB0AjLJRhjchbetWKh6lrZ8oSc7b1T8H9mjKnZ-DmM-WQjhOZcKqV0pr7tqS74GAPaZgr5v2HbcNbsmje75s1L8wyfvirndkDzH32LnAG-B55cj9t3VM2v2_vrvfQfewSP5Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2291157779</pqid></control><display><type>article</type><title>Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T</title><source>Wiley Online Library</source><source>Wiley Online Library Free Content</source><creator>Meissner, Jan‐Eric ; Korzowski, Andreas ; Regnery, Sebastian ; Goerke, Steffen ; Breitling, Johannes ; Floca, Ralf Omar ; Debus, Jürgen ; Schlemmer, Heinz‐Peter ; Ladd, Mark Edward ; Bachert, Peter ; Adeberg, Sebastian ; Paech, Daniel</creator><creatorcontrib>Meissner, Jan‐Eric ; Korzowski, Andreas ; Regnery, Sebastian ; Goerke, Steffen ; Breitling, Johannes ; Floca, Ralf Omar ; Debus, Jürgen ; Schlemmer, Heinz‐Peter ; Ladd, Mark Edward ; Bachert, Peter ; Adeberg, Sebastian ; Paech, Daniel</creatorcontrib><description>Background
Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro‐Oncology (RANO) takes a minimum of 4 weeks after the end of treatment.
Purpose/Hypothesis
To investigate whether chemical exchange saturation transfer (CEST) MRI enables earlier assessment of response to CRT in glioma patients.
Study Type
Longitudinal prospective study.
Population
Twelve brain tumor patients who underwent definitive CRT were included in this study. Three longitudinal CEST MRI measurements were performed for each patient at 7T: first before, second immediately after completion of CRT, and a third measurement as a 6‐week follow‐up.
Field Strength/Sequence
Conventional MRI (contrast‐enhanced, T2w and diffusion‐weighted imaging) at 3T and T2w and CEST MRI at 7T was performed for all patients.
Assessment
The mean relaxation‐compensated relayed nuclear‐Overhauser‐effect CEST signal (rNOE) and the mean downfield‐rNOE‐suppressed amide proton transfer (dns‐APT) CEST signal were investigated. Additionally, choline‐to‐N‐acetyl‐aspartate ratios (Cho/NAA) were evaluated using single‐voxel 1H‐MRS in six of these patients. Performance of obtained contrasts was analyzed in assessing treatment response as classified according to the updated RANO criteria.
Statistical Test
Unpaired Student's t‐test.
Results
The rNOE signal significantly separated stable and progressive disease directly after the end of therapy (post‐treatment normalized to pre‐treatment mean ± SD: rNOEresponder = 1.090 ± 0.110, rNOEnon‐responder = 0.808 ± 0.155, P = 0.015). In contrast, no significant difference was observed between either group when assessing the normalized dns‐APT (dns‐APTresponder = 0.953 ± 0.384, dns‐APTnon‐responder = 0.972 ± 0.477, P = 0.95). In the smaller MRS subcohort, normalized Cho/NAA decreased in therapy responders (Cho/NAAresponder = 0.632 ± 0.007, Cho/NAAnon‐responder = 0.946 ± 0.124, P = 0.070).
Data Conclusion
rNOE mediated CEST imaging at 7T allowed for discrimination of responders and non‐responders immediately after the end of CRT, additionally supported by 1H‐MRS data. This is at least 4 weeks earlier than the standard clinical evaluation according to RANO. Therefore, CEST MRI may enable early response assessment in glioma patients.
Level of Evidence: 1
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019;50:1268–1277.</description><identifier>ISSN: 1053-1807</identifier><identifier>EISSN: 1522-2586</identifier><identifier>DOI: 10.1002/jmri.26702</identifier><identifier>PMID: 30864193</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>1H MRS ; Brain cancer ; Brain tumors ; CEST‐MRI ; Chemoradiotherapy ; chemoradiotherapy response ; Chemotherapy ; Choline ; dns‐APT ; Exchanging ; Field strength ; Glioma ; Longitude ; Magnetic resonance imaging ; Medical imaging ; Neuroimaging ; Oncology ; Organic chemistry ; Patients ; Population studies ; Radiation therapy ; rNOE ; Saturation ; Statistical tests ; Therapy</subject><ispartof>Journal of magnetic resonance imaging, 2019-10, Vol.50 (4), p.1268-1277</ispartof><rights>2019 International Society for Magnetic Resonance in Medicine</rights><rights>2019 International Society for Magnetic Resonance in Medicine.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3572-a46fffb53d7e9b1ceda6799bced0f58371190ba20ed2f15addd7021cb247887f3</citedby><cites>FETCH-LOGICAL-c3572-a46fffb53d7e9b1ceda6799bced0f58371190ba20ed2f15addd7021cb247887f3</cites><orcidid>0000-0001-5755-6833</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fjmri.26702$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fjmri.26702$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27903,27904,45553,45554,46387,46811</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30864193$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meissner, Jan‐Eric</creatorcontrib><creatorcontrib>Korzowski, Andreas</creatorcontrib><creatorcontrib>Regnery, Sebastian</creatorcontrib><creatorcontrib>Goerke, Steffen</creatorcontrib><creatorcontrib>Breitling, Johannes</creatorcontrib><creatorcontrib>Floca, Ralf Omar</creatorcontrib><creatorcontrib>Debus, Jürgen</creatorcontrib><creatorcontrib>Schlemmer, Heinz‐Peter</creatorcontrib><creatorcontrib>Ladd, Mark Edward</creatorcontrib><creatorcontrib>Bachert, Peter</creatorcontrib><creatorcontrib>Adeberg, Sebastian</creatorcontrib><creatorcontrib>Paech, Daniel</creatorcontrib><title>Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T</title><title>Journal of magnetic resonance imaging</title><addtitle>J Magn Reson Imaging</addtitle><description>Background
Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro‐Oncology (RANO) takes a minimum of 4 weeks after the end of treatment.
Purpose/Hypothesis
To investigate whether chemical exchange saturation transfer (CEST) MRI enables earlier assessment of response to CRT in glioma patients.
Study Type
Longitudinal prospective study.
Population
Twelve brain tumor patients who underwent definitive CRT were included in this study. Three longitudinal CEST MRI measurements were performed for each patient at 7T: first before, second immediately after completion of CRT, and a third measurement as a 6‐week follow‐up.
Field Strength/Sequence
Conventional MRI (contrast‐enhanced, T2w and diffusion‐weighted imaging) at 3T and T2w and CEST MRI at 7T was performed for all patients.
Assessment
The mean relaxation‐compensated relayed nuclear‐Overhauser‐effect CEST signal (rNOE) and the mean downfield‐rNOE‐suppressed amide proton transfer (dns‐APT) CEST signal were investigated. Additionally, choline‐to‐N‐acetyl‐aspartate ratios (Cho/NAA) were evaluated using single‐voxel 1H‐MRS in six of these patients. Performance of obtained contrasts was analyzed in assessing treatment response as classified according to the updated RANO criteria.
Statistical Test
Unpaired Student's t‐test.
Results
The rNOE signal significantly separated stable and progressive disease directly after the end of therapy (post‐treatment normalized to pre‐treatment mean ± SD: rNOEresponder = 1.090 ± 0.110, rNOEnon‐responder = 0.808 ± 0.155, P = 0.015). In contrast, no significant difference was observed between either group when assessing the normalized dns‐APT (dns‐APTresponder = 0.953 ± 0.384, dns‐APTnon‐responder = 0.972 ± 0.477, P = 0.95). In the smaller MRS subcohort, normalized Cho/NAA decreased in therapy responders (Cho/NAAresponder = 0.632 ± 0.007, Cho/NAAnon‐responder = 0.946 ± 0.124, P = 0.070).
Data Conclusion
rNOE mediated CEST imaging at 7T allowed for discrimination of responders and non‐responders immediately after the end of CRT, additionally supported by 1H‐MRS data. This is at least 4 weeks earlier than the standard clinical evaluation according to RANO. Therefore, CEST MRI may enable early response assessment in glioma patients.
Level of Evidence: 1
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019;50:1268–1277.</description><subject>1H MRS</subject><subject>Brain cancer</subject><subject>Brain tumors</subject><subject>CEST‐MRI</subject><subject>Chemoradiotherapy</subject><subject>chemoradiotherapy response</subject><subject>Chemotherapy</subject><subject>Choline</subject><subject>dns‐APT</subject><subject>Exchanging</subject><subject>Field strength</subject><subject>Glioma</subject><subject>Longitude</subject><subject>Magnetic resonance imaging</subject><subject>Medical imaging</subject><subject>Neuroimaging</subject><subject>Oncology</subject><subject>Organic chemistry</subject><subject>Patients</subject><subject>Population studies</subject><subject>Radiation therapy</subject><subject>rNOE</subject><subject>Saturation</subject><subject>Statistical tests</subject><subject>Therapy</subject><issn>1053-1807</issn><issn>1522-2586</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kMFO3DAQQK0KVCjtpR-ALHGrFLCddRwfK7S0VCAkRM_RJB7vepXEqe0A-wX97XpZ6JGTR6OnN9Yj5Ctn55wxcbEZgjsXlWLiAznmUohCyLo6yDOTZcFrpo7Ipxg3jDGtF_IjOSpZXS24Lo_J3yWEfksDxsmPESnEiDEOOCbqLV31zg9AJ0gubyJNnhq0bnTJPSLt1jj4AMb5tMYA05bO0Y2rl73roKf43K1hXCGNkOaQJX6kKcAYLQbqBljtaEhU0YfP5NBCH_HL63tCfl8tHy5_Fjd3P64vv98UXSmVKGBRWWtbWRqFuuUdGqiU1m0emJV1qTjXrAXB0AjLJRhjchbetWKh6lrZ8oSc7b1T8H9mjKnZ-DmM-WQjhOZcKqV0pr7tqS74GAPaZgr5v2HbcNbsmje75s1L8wyfvirndkDzH32LnAG-B55cj9t3VM2v2_vrvfQfewSP5Q</recordid><startdate>201910</startdate><enddate>201910</enddate><creator>Meissner, Jan‐Eric</creator><creator>Korzowski, Andreas</creator><creator>Regnery, Sebastian</creator><creator>Goerke, Steffen</creator><creator>Breitling, Johannes</creator><creator>Floca, Ralf Omar</creator><creator>Debus, Jürgen</creator><creator>Schlemmer, Heinz‐Peter</creator><creator>Ladd, Mark Edward</creator><creator>Bachert, Peter</creator><creator>Adeberg, Sebastian</creator><creator>Paech, Daniel</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><orcidid>https://orcid.org/0000-0001-5755-6833</orcidid></search><sort><creationdate>201910</creationdate><title>Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T</title><author>Meissner, Jan‐Eric ; Korzowski, Andreas ; Regnery, Sebastian ; Goerke, Steffen ; Breitling, Johannes ; Floca, Ralf Omar ; Debus, Jürgen ; Schlemmer, Heinz‐Peter ; Ladd, Mark Edward ; Bachert, Peter ; Adeberg, Sebastian ; Paech, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3572-a46fffb53d7e9b1ceda6799bced0f58371190ba20ed2f15addd7021cb247887f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>1H MRS</topic><topic>Brain cancer</topic><topic>Brain tumors</topic><topic>CEST‐MRI</topic><topic>Chemoradiotherapy</topic><topic>chemoradiotherapy response</topic><topic>Chemotherapy</topic><topic>Choline</topic><topic>dns‐APT</topic><topic>Exchanging</topic><topic>Field strength</topic><topic>Glioma</topic><topic>Longitude</topic><topic>Magnetic resonance imaging</topic><topic>Medical imaging</topic><topic>Neuroimaging</topic><topic>Oncology</topic><topic>Organic chemistry</topic><topic>Patients</topic><topic>Population studies</topic><topic>Radiation therapy</topic><topic>rNOE</topic><topic>Saturation</topic><topic>Statistical tests</topic><topic>Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Meissner, Jan‐Eric</creatorcontrib><creatorcontrib>Korzowski, Andreas</creatorcontrib><creatorcontrib>Regnery, Sebastian</creatorcontrib><creatorcontrib>Goerke, Steffen</creatorcontrib><creatorcontrib>Breitling, Johannes</creatorcontrib><creatorcontrib>Floca, Ralf Omar</creatorcontrib><creatorcontrib>Debus, Jürgen</creatorcontrib><creatorcontrib>Schlemmer, Heinz‐Peter</creatorcontrib><creatorcontrib>Ladd, Mark Edward</creatorcontrib><creatorcontrib>Bachert, Peter</creatorcontrib><creatorcontrib>Adeberg, Sebastian</creatorcontrib><creatorcontrib>Paech, Daniel</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Journal of magnetic resonance imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Meissner, Jan‐Eric</au><au>Korzowski, Andreas</au><au>Regnery, Sebastian</au><au>Goerke, Steffen</au><au>Breitling, Johannes</au><au>Floca, Ralf Omar</au><au>Debus, Jürgen</au><au>Schlemmer, Heinz‐Peter</au><au>Ladd, Mark Edward</au><au>Bachert, Peter</au><au>Adeberg, Sebastian</au><au>Paech, Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T</atitle><jtitle>Journal of magnetic resonance imaging</jtitle><addtitle>J Magn Reson Imaging</addtitle><date>2019-10</date><risdate>2019</risdate><volume>50</volume><issue>4</issue><spage>1268</spage><epage>1277</epage><pages>1268-1277</pages><issn>1053-1807</issn><eissn>1522-2586</eissn><abstract>Background
Patients with newly diagnosed inoperable glioma receive chemoradiotherapy (CRT). Standard Response Assessment in Neuro‐Oncology (RANO) takes a minimum of 4 weeks after the end of treatment.
Purpose/Hypothesis
To investigate whether chemical exchange saturation transfer (CEST) MRI enables earlier assessment of response to CRT in glioma patients.
Study Type
Longitudinal prospective study.
Population
Twelve brain tumor patients who underwent definitive CRT were included in this study. Three longitudinal CEST MRI measurements were performed for each patient at 7T: first before, second immediately after completion of CRT, and a third measurement as a 6‐week follow‐up.
Field Strength/Sequence
Conventional MRI (contrast‐enhanced, T2w and diffusion‐weighted imaging) at 3T and T2w and CEST MRI at 7T was performed for all patients.
Assessment
The mean relaxation‐compensated relayed nuclear‐Overhauser‐effect CEST signal (rNOE) and the mean downfield‐rNOE‐suppressed amide proton transfer (dns‐APT) CEST signal were investigated. Additionally, choline‐to‐N‐acetyl‐aspartate ratios (Cho/NAA) were evaluated using single‐voxel 1H‐MRS in six of these patients. Performance of obtained contrasts was analyzed in assessing treatment response as classified according to the updated RANO criteria.
Statistical Test
Unpaired Student's t‐test.
Results
The rNOE signal significantly separated stable and progressive disease directly after the end of therapy (post‐treatment normalized to pre‐treatment mean ± SD: rNOEresponder = 1.090 ± 0.110, rNOEnon‐responder = 0.808 ± 0.155, P = 0.015). In contrast, no significant difference was observed between either group when assessing the normalized dns‐APT (dns‐APTresponder = 0.953 ± 0.384, dns‐APTnon‐responder = 0.972 ± 0.477, P = 0.95). In the smaller MRS subcohort, normalized Cho/NAA decreased in therapy responders (Cho/NAAresponder = 0.632 ± 0.007, Cho/NAAnon‐responder = 0.946 ± 0.124, P = 0.070).
Data Conclusion
rNOE mediated CEST imaging at 7T allowed for discrimination of responders and non‐responders immediately after the end of CRT, additionally supported by 1H‐MRS data. This is at least 4 weeks earlier than the standard clinical evaluation according to RANO. Therefore, CEST MRI may enable early response assessment in glioma patients.
Level of Evidence: 1
Technical Efficacy Stage: 5
J. Magn. Reson. Imaging 2019;50:1268–1277.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>30864193</pmid><doi>10.1002/jmri.26702</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5755-6833</orcidid></addata></record> |
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| subjects | 1H MRS Brain cancer Brain tumors CEST‐MRI Chemoradiotherapy chemoradiotherapy response Chemotherapy Choline dns‐APT Exchanging Field strength Glioma Longitude Magnetic resonance imaging Medical imaging Neuroimaging Oncology Organic chemistry Patients Population studies Radiation therapy rNOE Saturation Statistical tests Therapy |
| title | Early response assessment of glioma patients to definitive chemoradiotherapy using chemical exchange saturation transfer imaging at 7 T |
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